Intensive interaction

Intensive Interaction is an approach for supporting the social inclusion and social communication skill development for people with learning difficulties and/or autism who have difficulty with social engagement. The approach focuses on teaching the communication concepts and performances that precede speech development. The approach is additionally used to promote social engagement and learning for people who, for a range of reasons, find sociability problematic.

History

Intensive interaction was developed by teachers Dave Hewett and Melanie Nind at Harperbury Hospital School in Southern England during the 1980s. The development of the approach came about as a result of practitioners exploring effective teaching approaches that moved away from the dominance of behavioural psychology.

In 1981 the staff of Harperbury Hospital School commenced discussion and experimentation around their teaching techniques, particularly focusing on the teaching of communication. By 1982 the team had formulated the concept of an 'Appropriate Communication Environment' (ACE), thus addressing the primary learning needs of their young adult learners with severe or profound learning difficulties, that being improved sociability and social communication. Such an ACE environment was seen to support learners in experiencing and thus learning about social communication through active participation in playful social engagements; these previously having been absent from their lives.

In 1983 Dave Hewett and others from the Harperbury team met with clinical psychologist Dr Geraint Ephraim, who worked locally at Leavesden Mental Hospital. Dr Ephraim had been working on another socially interactive approach called ‘Augmented Mothering’ used with institutionalised residents at Leavesden, and he pointed the Harperbury team to read up on the emerging parent-infant interaction literature.

By 1984 the Harperbury team changed the name of their approach to "Intensive Interaction" to better describe its main features. In 1985 Melanie Nind joined the staff team at Harperbury School as first-year teacher; at this point having already published on work with deaf-blind children using van Dijk's 'co-active movement'.

In 1988 the first publication on Intensive Interaction was a paper in the British Journal of Special Education: Nind, M. & Hewett, D. (1988) 'Interaction as Curriculum', British Journal of Special Education, 15(2), 55-57. This seminal paper was quickly followed by Hewett, D. & Nind, M. (1988) 'Developing an Interactive Curriculum for Pupils with Severe and Complex Learning Difficulties', in Smith, B. (Ed) Interactive Approaches to the Education of Children with Severe Learning Difficulties. Birmingham: Westhill College.

These first publications created a lot of interest across the UK, with Hewett and Nind then invited to speak at a number of special education conferences and give talks and training sessions for interested staff teams across the UK.

Generally, the responsive and learner-led techniques of Intensive Interaction are informed by an understanding of how infants are supported in their learning of the highly complex and interrelated skills of human social communication. In such parent-infant interactions, infants gradually accrue an understanding of the basic principles and practices of human social communication by taking part in many responsive, cumulative interactions with the adults around them. Thus the learning develops through repeated, highly responsive, rather than directive engagements.

The gradual dissemination of intensive interaction since the late 1980s has been a completely practitioner-led initiative. Intensive Interaction is now common practice in special schools and adult services all over the United Kingdom. Interest worldwide is growing and developing. There are a range of books and other materials now available and a burgeoning community of Intensive Interaction practitioners.

Intended use

Intensive interaction is intended to address the needs of:

• People who are pre-verbal, with few or limited communicative behaviours.
• People who are extremely socially withdrawn, and do not positively interact with other people.
• People who display various stereotyped or self-stimulatory behaviours that exclude the participation of other people.[1]

The "fundamentals of communication" are typically referred to as being attainments such as:

• enjoying being with another person
• developing the ability to attend to that person
• concentration and attention span
• learning to do sequences of activity with the other person
• taking turns in exchanges of behaviour
• sharing personal space
• using and understanding eye contacts
• using and understanding facial expressions
• using and understanding physical contacts
• using and understanding non-verbal communication
• using vocalisations with meaning (for some, speech development)
• learning to regulate and control arousal levels

Further reading

• Barber, M. & Firth, G. (2019) 'Delivering Intensive Interaction Across Settings: Practice, Community and Leadership', KDP, Melbourne.
• Firth, G., Berry, R. & Irvine, C. (2010) 'Understanding Intensive Interaction: Context and Concepts for Professionals and Families'. London: Jessica Kingsley Publishers.
• Firth, G. & Barber, M. (2011) 'Using Intensive Interaction with a Person with a Social or Communicative Impairment'. London: Jessica Kingsley Publishers.
• Hewett, D. (Ed) (2011) 'Intensive Interaction - Theoretical Perspectives'. London: Sage Publications.
• Hewett, D., Firth, G., Barber, M. & Harrison, T. (2012) 'The Intensive Interaction Handbook'. London: Sage Publications.
• Hewett, D. & Nind, M. (Eds) (1998) 'Interaction in Action: Reflections on the Use of Intensive Interaction'. London: David Fulton.
• Kellett, M. & Nind, M. (2003) 'Implementing Intensive Interaction in Schools: Guidance for Practitioners, Managers and Coordinators'. London: David Fulton.
• Mourière, A. & McKim, J. (Eds) (2018) 'Integrating Intensive Interaction: developing communication with children and adults with Severe Learning Difficulties, Profound and Multiple Learning Difficulties and Autism'.  London: Routledge.
• Mourière, A. & Smith, P. (Eds) (2022) 'The Intensive Interaction Classroom Guide: Social Communication Learning and Curriculum for Children with Autism, Profound and Multiple Learning Difficulties, or Communication Difficulties'. London: Routledge.
• Nind, M. & Hewett, D. (2005) 'Access to Communication (2nd edition): Developing the basics of communication with people with severe learning difficulties through Intensive Interaction'. London: David Fulton.

Additional published literature

• Argyropoulou, Z. & Papoudi, D. (2012) ‘The training of a child with autism in a Greek preschool inclusive class through Intensive Interaction: a case study.’ European Journal of Special Needs Education, 27(1), 99-114.
• Barber, M. (2008) ‘Using Intensive Interaction to add to the palette of interactive possibilities in teacher-pupil communication.’ European Journal of Special Needs Education, 23(4), 393–402.
• Berry, R., Firth, G., Leeming, C. & Sharma, V. (2013) ‘Clinical Psychologists’ Views of Intensive Interaction as an Intervention in Learning Disability Services’, Clinical Psychology & Psychotherapy, 21(5), 403–410.
• Elgie, S. & Maguire, N. (2001) 'Intensive Interaction with a Woman with Multiple and Profound Disabilities; a case study.’ Tizard Learning Disability Review, 6(3), 18-24.
• Firth, G., Elford, H., Leeming, C., & Crabbe, M. (2008) ‘Intensive Interaction as a Novel Approach in Social Care: Care Staff’s Views on the Practice Change Process.’ Journal of Applied Research in Intellectual Disabilities, 21, 58–69.
• Fraser, C. (2011) ‘Can adults on the autism spectrum be affected positively by the use of intensive interaction in supported living services?’, Good Autism Practice, 12(2), 37–42.
• Harris, C. & Wolverson, E. (2014) ‘Intensive Interaction: to build fulfilling relationships’, The Journal of Dementia Care, 22(6), 27-30.
• Hutchinson, N. & Bodicoat, A. (2015) ‘The Effectiveness of Intensive Interaction: A Systematic Literature Review’, Journal of Applied Research in Intellectual Disabilities, 28(6), 437–454.
• Kellett, M. (2000) ‘Sam’s Story: Evaluating Intensive Interaction in Terms of its Effect on the Social and Communicative Ability of a Young Child With Severe Learning Difficulties’, Support for Learning, 15(4), 165–171.
• Kellett, M. (2005) ‘Catherine’s Legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies.’ British Journal of Special Education, 32(3), 116–121.
• Leaning, B. & Watson T. (2006) ‘From the inside looking out – an Intensive Interaction group for people with profound and multiple learning disabilities.’ British Journal of Learning Disabilities, 34, 103–109.
• Lovell, D., Jones, S. & Ephraim, G. (1998) ‘The Effect of Intensive Interaction on the Sociability of a Man with Severe Intellectual Disabilities.’ International Journal of Practical Approaches to Disability, 22(2/3), 3–8.
• Nind, M. (1996) ‘Efficacy of Intensive Interaction; Developing sociability and communication in people with severe and complex learning difficulties using an approach based on caregiver- infant interaction.’ European Journal of Special Educational Needs, 11(1), 48–66.
• Rayner, K., Bradley, S., Johnson, G., Mrozik, J., Appiah, A. & Nagra, M. (2016) ‘Teaching Intensive Interaction to paid carers: using the ‘communities of practice’ model to inform training’, British Journal of Learning Disabilities, 44(1), 63–70.
• Samuel, J., Nind, M., Volans, A. & Scriven, I. (2008) ‘An evaluation of Intensive Interaction in community living settings for adults with profound intellectual disabilities.' Journal of Intellectual Disabilities, 12, 111-126.
• Sharma, V. & Firth, G. (2012) ‘Effective engagement through Intensive Interaction’, Learning Disability Practice, 15(9), 20–23.
• Watson, J. & Fisher, A. (1997) ‘Evaluating the Effectiveness of Intensive Interaction Teaching with Pupils with Profound and Complex Learning Disabilities.’ British Journal of Special Education, 24(2), 80–87.
• Watson, J. & Knight, C. (1991) ‘An Evaluation of Intensive Interactive Teaching with Pupils with Very Severe Learning Difficulties.’ Child Language Teaching and Therapy, 7(3), 310–25.
• Zeedyk, S., Davies, C., Parry, S. & Caldwell, P. (2009) ‘Fostering social engagement in Romanian children with communicative impairments: The experiences of newly trained practitioners of Intensive Interaction.’ British Journal of Learning Disabilities, 37(3), 186–196.
• Zeedyk, S., Caldwell, P. & Davies, C. (2009) ‘How rapidly does Intensive Interaction promote social engagement for adults with profound learning disabilities and communicative impairments?’ European Journal of Special Needs Education, 24(2), 119–137.

External links

• Intensive Interaction Institute, an organization for the advancement of intensive interaction